Provider Demographics
NPI:1831399468
Name:BLADES, JOYCE ELLEN (MS, RD)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ELLEN
Last Name:BLADES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 N BASS LAKE RD
Mailing Address - Street 2:BOX 152
Mailing Address - City:PIERSON
Mailing Address - State:MI
Mailing Address - Zip Code:49339-9423
Mailing Address - Country:US
Mailing Address - Phone:616-636-5956
Mailing Address - Fax:616-636-5956
Practice Address - Street 1:3390 N BASS LAKE RD
Practice Address - Street 2:BOX 152
Practice Address - City:PIERSON
Practice Address - State:MI
Practice Address - Zip Code:49339-9423
Practice Address - Country:US
Practice Address - Phone:616-636-5956
Practice Address - Fax:616-636-5956
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered